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Neurological System > 3-ENT > Flashcards

3-ENT Flashcards

1
Q

Describe premalignant lesions of the upper aerodigestive tract

A

Leukoplakia: white/whitish area. Can NOT be easily scraped off without bleeding. 5% cancerous or become cancerous in 10 years.

Erythroplakia: raised red area. May bleed if scraped. Higher chance of becoming cancerous (up to 70%).

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2
Q

Know the workup of a head and neck mass

A

MOST COMMON: Squamous cell carcinoma (SCCA): (90%). Do not usually metastasize.

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3
Q

Majority of Lower lip cancers?

A

Lower lip - 90% squamous cell

Upper lip - rare, usually basal cell carcinoma

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4
Q

Know the role of HPV in the development of head and neck cancer

A

50% of SCCA of oropharynx HPV positive.

Etiology: younger; decreased tobacco and alcohol utilization.

Presentation: cystic neck mass (fluid in lymph node).

High risk: number of sexual partners (> 7); oral-genital sex (> 4 partners); open mouth kissing.

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5
Q

Identify the histologic findings of squamous cell carcinoma

A

Histology: keratinizing swirls (pearls).

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6
Q

Describe the pathophysiology of commonly encountered salivary gland neoplasms

A

Parotid tumor: benign (painless mass).

Pleomorphic ademona: benign mixed tumor. Most common salivary gland neoplasm. 4th-6th decade.

Warthin tumor: 2nd most common parotid neoplasm.

Oncocytoma: rare (2.3% benign neoplasms). 6th decade.

Monomorphic adenoma: rare. Basal cell (most common); canalicular; sebaceous; glycogen-rich; clear cell adenoma; myoepithelioma.

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7
Q

Describe Pleomorphic adenoma.

A

benign mixed tumor. Most common salivary gland neoplasm. 4th-6th decade.

Location: parotid (85%); minor salivary glands (10%).

Features: solitary; slow-growing; painless; firm mass.

Treatment: superficial parotidectomy (facial nerve preservation); enucleation (high local recurrence).

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8
Q

Describe Warthin Tumors

A

2nd most common parotid neoplasm. 4th-7th decade. Male (5:1).

Association: tobacco; alcohol.

Feature: slow-growing; painless; firm; bilateral; straw colored fluid (aspirate).

Treatment: superficial parotidectomy (facial nerve preservation).

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9
Q

Be able to identify the differences between benign and malignant lesions of the salivary glands

A

Mucoepidermoid carcinoma: most common parotid malignancy (30-45%). 20-70 years (peak in 5th decade). Most common salivary gland malignancy in pediatric and adolescent population.

Adenoid cystic carcinoma: second most common.

Acinic cell carcinoma: 2nd most common malignancy in children.

Carcinoma ex-pleomorphic adenoma: malignant transformation over 10-15 years; 25% cervical node involvement.

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10
Q

Describe Mucoepidermoid carcinoma:

A

most common parotid malignancy (30-45%). 20-70 years (peak in 5th decade). Most common salivary gland malignancy in pediatric and adolescent population. Men.

Prognosis: low grade (well differentiated; 70% 5 year survival); high grade (poorly differentiated; 50% five year survival).

Location: parotid (45-70%); palate (18%).
Features: pain; fixation to surrounding tissue; facial paralysis.

Treatment: stage I, II (parotidectomy with facial nerve preservation); stage III, IV (radical excision; postoperative radiation).

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11
Q

Describe Adenoid cystic carcinoma:

A

second most common.
Features: perineural invasion (facial weakness); metastatic spread to lungs.
Prognosis: poor ten year survival.
Treatment: parotidectomy plus radiation.

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12
Q

Describe Acinic cell carcinoma:

A

2nd most common malignancy in children.

Treatment: surgical excision. May have distant metastasis years after initial treatment.

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13
Q

Histological aspects of Pleomophic adenoma

A

smooth/lobulated, well-encapsulated tumor clearly demarcated from surrounding normal salivary gland.

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14
Q

Histological aspects of Warthin tumor

A

multiple cysts; epithelial cells forming papillary projections into cystic spaces in background of lymphoid stroma; double cell layer epithelium.

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15
Q

Histological aspects of Oncocytoma:

A

large number of mitochondria; Bensley aniline-acid fuchsin stain. Uniform plump oncocytes with granular eosinophilic cytoplasm arranged in glandular pattern.

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16
Q

Histological aspects of Mucoepidermoid carcinoma

A

solid and cystic areas.

Low grade: more mucus cells; fewer epidermoid. Left.

High grade: more epithelial; less mucin. Positive staining for mucin. Right.

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17
Q

Histological aspects of adenoid cystic carcinoma

A

SWISS CHEESE PATTERN

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18
Q

Histological aspects of Acinic cell carcinoma

A

solid, microcystic, papillary cystic, follicular. Dark staining with granular/honeycomb cytoplasm.

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19
Q

Understand basic treatments of salivary gland neoplasms

A

Parotid malignancies:
Superficial parotidectomy with nerve preservation.
Total parotidectomy with nerve preservation.
Radical parotidectomy (gland and nerves).
Parotidectomy and temporal bone resection.

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20
Q

Be familiar with theories regarding tumorigenisis of salivary gland neoplasms

A

Bicellular theory: neoplastic development originates from basal cells in excretory and intercalated ducts.
Excretory duct: squamous cell carcinoma; mucopeidermoid carcinoma.
Intercalated duct: pleomorphic adenoma; Warthin

Multicellular theory: neoplasm develop from differentiated cells.
Striated duct: oncocytic tumor.
Acinar cells: acinic cell carcinoma.
Excretory duct: squamous cell carcinoma; mucoepidermoid carcinoma.
Intercalated duct: myoepithelial cells (pleomorphic tumors).

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21
Q

Bicellular theory of neoplastic development. Neoplasms associated with excretory duct?

A

Squamous cell

Mucoepidermoid

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22
Q

Bicellular theory of neoplastic development. Neoplasms associated with intercalated duct?

A 
(Everything except squamous and mucoepidermoid)!!!!!!!!!!!
Pleomorphic adenoma
Warthins Tumors
Oncocytoma
Acinic Cell 
Adenoid Cystic
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23
Q

Bilateral parotid tumor name?

A

Warthins

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24
Q

Painless. Clearly demarcated from surrounding tissue. Smooth, lobulated, well-encapsulated, pseudopods under microscope. Unilateral parotid tumor?

A

Pleomorphic adenoma

MOST COMMON OF ALL SALIVARY NEOPLASMS

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25
Q

Most common salivary MALIGNANCY. not neoplasm?

A

Mucoepidermoid carcinoma

Fixation of the surrounding tissue is a bad sign.

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26
Q

Second most common salivary malignancy? Most important characteristic to worry about?

A

Adenoid cystic carcinoma

Worry about perineural invasion

27
Q

2nd most common childhood salivary malignancy?

A

Acinic cell

28
Q

What population, other than smokers and HPV are at high risk for head/neck cancer?

A

Transplant patients, due to immuno-suppressive therapy

29
Q

Describe ENT evaluation of a neck mass?

A

Refer to specialist if longer than 3wks duration

Full Head/Neck Exam
Fine Needle Aspiration
CT scan of neck

30
Q

Why does HPV cause an increased chance of head/neck cancer?

A

Molecular dysregulation

E6 decreases P53 activity
E7 decreases RB activity

31
Q

What is ABR and what is it used for?

A

Auditory Brainstem Response - measures potential from CN VIII, in patients unable/unwilling to cooperate to rule out retrocochlear lesions (acoustic tumors and brainstem disease)

32
Q

Purpose of the organ of corti?

A

in scala media, transduces mechanical sound to electrical (neuronal) signal.

33
Q

Frequency distribution of cochlea?

A 
Base = 20,000hz
Apex = 200hz
34
Q

Define conductive hearing loss?

A

Caused by interference of sound conduction through external or middle ear

35
Q

Define sensorineural hearing loss?

A

Abnormalities involving cochlea or auditory nerve

36
Q

Describe Upsloping SNHL and what disease it is associated with?

A

Hearing is best at higher frequencies

Menieres disease

37
Q

Describe downsloping SNHL

A

aka. Presbycusis
Seen in age related hearing loss

Hearing progressively worse at higher frequencies

38
Q

Describe the characteristics of noise induced SNHL.

A

Hearing loss peak on graph of frequencies at 4000 Hz.

Will progress to other frequencies over time.

39
Q

What is tympanometry?

A

Tests Acoustic impedance related to middle ear function, eustachian tube functioning, and acoustic reflex.

40
Q

Describe the types of tympanometry graph results and their likely causes.

A

Flat - fluid in middle ear
Negative - eustachian tube dysfunction

Notched: flaccid membrane or fracture of ossicles

41
Q

When is a bone implanted hearing aide used?

A

In patients with chronic ear infections or with profound SNHL on one side

42
Q

When is a chochlear implant used?

A

Patients who are bilarterally profoundly or totally deaf.

Electrodes deliver sounds directly to the auditory nerve.

43
Q

Chondrodermatitis Nodularis Helicis

A

Chronic perichondritis.

Benign lesion of pinna.

Treatment: long-term oral antibiotics (may improve); excision (including cartilage).

44
Q

Fungal Otitis Externa (Otomycosis)

A

White/black mycelia; visible spores; purulent discharge.
Appearance: “bread mold” in ear.

Treatment: suction/debridement.

45
Q

Tympanoslerosis

A

Tympanic membrane: white plaques of submucosal hyalinization/calcification. Generally does not affect hearing.

Middle ear: nodular deposits (basement membrane of mucosa; may fix ossicles).

May affect hearing if extensive.

Firm to the touch.

46
Q

Acute Otitis Media (AOM)

A

Micro: s. pneumoniae; h. influenze; m. catarrhalis.

Symptoms: fever; otalgia; hearing loss; drainage.

Signs: inflamed/bulging TM; exudate; drainage.

Treatment: antibiotics; myringotomy.
Amoxicillin, augmentin, augmentin ES, cephalosporin (2nd gen), Bactrim.

Neonatal: 20% gram- bacilli (pseudomonas) and staph.

Complications: persistent effusion; TM perforation; ossicular damage; facial paralysis; labyrinthitis; epidural/brain abscess.

47
Q

Bullous Myringitis

A

Variant of otitis media, has blistering of tympanic membrane

48
Q

Coalescent Mastoidtitis

A

Bulging in post auricular area (need surgery immediately).

Intracranial complications: epidural/subdural/brain abscess; sigmoid sinus thrombosis; otitic hydrocephalus; meningitis.

49
Q

Eustachian Tube Dysfunction

A

Etiology: allergic; immunologic; ciliary dysfunction; adenoid obstruction.

Symptoms: hearing loss; fullness in ear; dizziness if unilateral.

Treatment: repair clefts; treat allergies; adenoidectomy; myringotomy with tympanostomy (tubes; remain in place 6-18 months).

50
Q

Barotrauma

A

Etiology: rapid descent; flying with Eustachian tube dysfunction.

Symptoms: severe pain; hearing loss; aural fullness; dizziness.

Signs: retracted TM; ecchymotic TM; hemotympanum.

Treatment: avoidance (slow descent; frequent clearing; decongestants); myringotomy with tube.

51
Q

Cholesteatoma

A

Etiology: collection of debris in retraction pocket; ingrowth of squamous debris through perforation. Pars flaccida prone to retraction/perforation.

Symptoms: drainage; hearing loss; dizziness; minimal pain.

Signs: keratin debris; drainage; granulations; polyp (aural); CN VII palsy.

Treatment: surgery; debridement (non-surgical candidate).

52
Q

Aural Polyp and Cholesteatoma

A

Path: infected granulation tissue associated with cholesteatoma and chronic otomastoiditis.

Micro: mixed (pseudomonas, staph).

Symptoms/Signs: dizziness; facial paralysis (late complication).

Treatment: debridement of polyp; antibiotic; surgery (remove cholesteatoma).

53
Q

Meniere Disease

A

Etiology: altered fluid dynamics (rupture of inner ear membranes; short-circuiting of inner ear).

Symptoms: episodic vertigo; fluctuating hearing loss; tinnitus; aural fullness (sudden onset).

Signs: normal exam; low-frequency SNHL; nystagmus (acute). Bilateral (20-30%).

Treatment: low salt diet; diuretic; vestibular suppressants (meclizine; valium; scopolamine).

54
Q

Acoustic Neuroma

A

Schwannoma of CN VIII; benign; slow growing.

Symptoms: unilateral SNHL/tinnitus; disequilibrium.

Diagnosis: audiogram/ABR; MRI/CT.

Treatment: gamma knife; surgical excision.

55
Q

Curable SNHL

A

Sphylitic: penicillin and prednisone.

Autoimmune: prednisone; Cytoxan.

Perilympatic fistula: surgical repair. Rare, due to trauma.

56
Q

Perilymphatic Fistula

A

Etiology: head trauma; otic trauma (barotrauma); infection (chronic otitis media); cholesteatoma.

Symptoms: positional vertigo; disequilibrium; sudden hearing loss.

Treatment: exploration and repair (promptly).

57
Q

What is the rima glottidus?

A

Opening between the true vocal cords

58
Q

What opens/abducts the vocal cords?

A

Posterior cricoarytenoid muscle

Innervated by recurrent laryngeal

59
Q

Most common form of vocal paralysis?

A

Iatrogenic via carotid or thyroid surgery

60
Q

Best treatment for singers nodules?

A

Speech therapy

61
Q

Signs of acute epiglottitus?

A

muffled voice, leaning forward, mouth open, drooling

intubate immediately

62
Q

What is the most important part of treating a bell’s palsy?

A

Be sure to protect the eye from drying out.

63
Q

Describe ramsey hunt syndrome

A

Herpes zoster oticus or Ramsay Hunt syndrome (6%-12% of facial paralysis) presents with severe ear pain, facial paralysis, as well as skin or mucosal vesicular eruptions. The detection of vesicles (ear, face, or palate) is critical in establishing the diagnosis, remembering that the vesicles may appear in a delayed fashion (up to 10 days after facial weakness). Hearing loss and vestibular abnormalities may be present (10%-40%) and portend a worse prognosis. Corticosteroids and antivirals are the mainstays of therapy. Appropriate analgesics are needed. Topical antibiotics will prevent bacterial infection of the vesicles. Remember eye care. All patients will regain some function with only about 60% recovering normal facial nerve function and the remainder suffering synkinesis or residual weakness

64
Q

What is the most common cause of angioedema?

A

Iatrogenic: ACE inhibitors

Neurological System (10 decks)

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